Conventional surgical practice involves the closure of skin wounds with the use of sutures, clamps, adhesive materials or other similar means.
It is well recognized that skin wounds, whether created by trauma or as a result of surgery, should be closed as soon as possible to avoid contamination and infection, and to minimize the development of scar tissue. The deliberate creation of skin wounds by surgery conventionally requires closure of the wound immediately following the surgery to avoid contamination of the wound and to facilitate repair of the tissue so that the patient may be returned to his normal environment.
Simple suturing of the skin has persisted as a dominant method of skin closure at the present time under a wide range of circumstances. The speed of surgery, however, has developed as an important facet of medical procedure and faster methods for skin closure have been developed, including the use of staples as an accepted method.
In an effort to provide rapid skin closure, a variety of alternatives to sutures and staples have been developed. For example, the following patents disclose various types of brackets which are adhesively affixed to the skin adjacent a wound and are then releasably secured together to close the wound: U.S. Pat. Nos. 4,114,624, 3,933,158, 3,863,640 to Haverstock; U.S. Pat. No. 3,516,909 to Howell; Australian Pat. No. 477,704 to Kawchitch; and West German Pat. No. 2,038,038 to Keil. In addition, the following patents disclose various types of brackets which are affixed to the skin by pins adjacent a wound and are then releasably secured together to close the wound: U.S. Pat. No. 3,825,010 to McDonald and U.S. Pat. No. 4,073,298 to LeRoy. U.S. Pat. No. 1,452,372 to Gomez discloses a skin closure device of the general type discussed above in which both adhesives and pins are used to secure the brackets to the skin.
At the present time, under normal circumstances, there are three generally recognized methods of skin closure. One involves a simple bandaging of the skin with an adhesive material which involves pulling the skin edges together from edge-to-edge with adhesive straps. Another method involves the suturing of wounds through use of a variety of skin suture methods. The third involves skin closure by stapling the skin edges together. In addition, a fourth approach is to use one of the separable brackets discussed above, though the majority of these brackets have not achieved widespread acceptance.
Skin closure is a particular problem when skin must be drawn across a region from which the epidermis and subcutaneous layers are absent in order to close a wound. Such a region will sometimes be called a "denuded area" in the following specification and claims. For example, certain kinds of trauma can bruise, gouge or remove large strips of skin, leaving a wound which is denuded over a significant width. Similarly, after amputation of a limb, a relatively large denuded area is exposed. It would be advantageous to draw skin together from the marginal edges of such a wound in order to bring about speedy closure of the wound. However, this approach has met with considerable difficulty in the past. When sutures are used in an attempt to close such a wound, it is generally not feasible to tighten the sutures progressively as required to close the wound gradually. Similarly, the use of adhesive bandages to bond the superficial layer of the skin and then to pull the superficial layer of the skin on opposite sides of the wound together has also been found unsatisfactory in many cases. Thus, a need exists for an improved means and method of skin closure which will allow skin to be pulled together over a denuded region.
The skin closure devices set forth herein provide significant improvements over the skin closure devices discussed above.